经颅多普勒超声在不明原因缺血性脑卒中的应用研究

目的探讨经颅多普勒超声(transcranial Doppler,TCD)技术结合生理盐水发泡试验在不明原因缺血性脑卒中患者卵圆孔未闭(PFO)筛查中的应用价值。方法收集51例55岁以下不明原因缺血性脑卒中患者,行TCD结合生理盐水发泡试验和经胸超声心动图(TTE)检查。结果 51例患者中,23例患者TCD检查栓子信号阳性,其中18例患者TTE检查发现PFO,而在28例TCD检查栓子信号阴性的患者中未发现PFO;TCD检查阳性患者中偏头痛发病率、合并下肢深静脉血栓比例以及房间隔瘤比例较阴性者高(P<0.05)。结论 TCD结合生理盐水发泡试验是筛查PFO的有效手段,可以作为不明原因缺血性脑卒中病因筛查的手段。     

合并心脏卵圆孔未闭脑卒中12例临床特点分析

目的：探讨合并心脏卵圆孔未闭脑卒中患者的临床特点。方法：回顾性研究2008至2010年收治的合并心脏卵圆孔未闭的脑卒中12例患者的临床资料。结果：本组12例患者中,有高血压史2例、吸烟史3例。卵圆孔缺损≥2mm者10例（83.3%）,年龄〈55岁8例（66.7%）,有偏头痛病史3例（25.0%）。头颅MRI示梗死位于额叶皮质下及顶叶皮质下各7例（58.3%）,前循环供血区7例（58.3%）。结论：合并心脏卵圆孔未闭的缺血性脑卒中患者发病年龄偏小,偏头痛病是其并发症;卵圆孔缺损≥2mm者易罹患脑卒中。     

早期血管再通治疗青年缺血性脑卒中的临床影像 发病特征及疗效分析

目的分析青年缺血性脑卒中患者的临床、影像学特征分布及早期血管再通治疗安全性及疗效。方法收集2017—2018年在首都医科大学宣武医院急诊绿色通道就诊,确诊为缺血性脑卒中收住入院并行早期血管再通治疗的37例青年患者,回顾性分析其临床及影像学特征,总结分析青年缺血性脑卒中的发病特点及早期血管再通治疗的疗效。结果纳入37例早期血管再通青年缺血性脑卒中患者,年龄(37.05±6.47)岁,男性29例(78.4%),9例年龄≤35岁(24.2%);常见危险因素:肥胖(73.0%)、吸烟(64.9%)、饮酒(56.8%)、高低密度脂蛋血症(40.5%)、高血压(37.8%)、高同型半胱氨酸血症(35.1%)。TOAST病因分型:大动脉粥样硬化12例(32.4%),心源性栓塞3例(8.1%),小动脉闭塞12例(32.4%),其他明确病因6例(16.2%),病因不明4例(10.8%)。大动脉粥样硬化病例中前循环7例,后循环5例;3例为心源性栓塞,包括心脏瓣膜病、心肌病、卵圆孔未闭合并反复栓塞事件;其他明确病因中,最常见于脑动脉夹层(3/6),其他包括烟雾病(1/6)、大动脉炎(1/6)、脂肪栓塞(1/6)。入院美国国立卫生研究院卒中量表评分平均9.8分,出院改良Rankin量表评分2.16分;住院期间并发症多发生介入治疗患者,以肺部感染、泌尿系感染最常见。3组接受早期血管再通治疗的患者,神经功能缺损评分治疗后均有所改善,但静脉溶栓组以小血管病型多见,出院时改良Rankin量表评分改善幅度更为明显,该组人群入组时NIHSS评份低。结论早期发现危险因素、明确病因分型有利于青年缺血性脑卒中的防治,青年缺血性脑卒中患者早期血管再通治疗可显著改善神经功能评分,血管再通效果良好,安全性好,实用性强。     

青年脑梗死的危险因素及病因TOAST分型研究

目的探讨青年脑梗死的常见危险因素及病因TOAST分型,为预防和控制青年缺血性脑卒中的发生提出有效的预防对策及制定干预措施。方法对近年来收治的148例青年缺血性脑卒中病历资料进行回顾性分析,归纳统计危险致病因素及病因,探讨发病的常见危险因素及TOAST分型。结果青年脑梗死最主要的危险因素是高血压。其他原因如高同型半胱氨酸血症、动脉炎性疾病、脑动脉夹层、卵圆孔未闭、可逆性脑血管收缩综合征等。病因TOAST分型为大动脉粥样硬化性脑梗死16.3%,心源性脑栓塞型17.5%,小动脉脑梗死23.7%,其他原因所致脑梗死10.0%,原因不明的脑梗死32.5%。结论青年患者应努力改变不良的生活方式,早期防治高血压、高血脂、高血糖及心脏疾病,同时重视不明原因的发热、头痛、颈痛等症状及少见危险因素,及早诊断和治疗,积极寻找病因,避免青年脑卒中事件的发生。     

青年缺血性卒中45例病因及危险因素分析

目的 探讨青年脑卒中患者的病因及危险因素.方法 回顾性分析45例青年缺血性卒中患者的临床资料,并与33例中老年缺血性卒中资料进行比较分析.结果 青年卒中组病因及危险因素依次为高血压、高血脂、动脉粥样硬化、吸烟、饮酒、高纤维蛋白原血症、高同型半胱氨酸血症,糖尿病,偏头痛,动脉夹层,卵圆孔未闭,大动脉炎.两组比较,青年组高脂血症、偏头痛、动脉夹层具有显著性统计学意义.结论 青年卒中病因及危险因素与中老年组不完全相同,积极治疗高血脂症、偏头痛及动脉夹层,对青年缺血性卒中的预防意义更大.     

大脑中动脉粥样硬化形成的青年脑梗死1例报告

目的提高对中青年脑卒中常见病因的认识。方法汇报1例青年急性脑卒中病例,对青年脑梗死的病因、流行病特点及预后进行分析,并结合相关文献进行文献复习。结果大脑中动脉狭窄的青年脑卒中患者相对症状轻,且预后相对较好,动脉粥样硬化仍是我国青年颅内动脉狭窄最常见原因;其他病因包括烟雾病、血管炎、夹层、自身免疫性疾病、血液系统疾病、抗磷脂抗体综合征、肿瘤卒中、风湿性心脏瓣膜病、房颤、房间隔缺损、卵圆孔未闭、心房黏液瘤、扩张性心肌病等。结论青年脑卒中的危险因素及病因学特点广泛而复杂,诊治过程中需系统全面地寻找病因及危险因素,从而进行有效的个体化预防和治疗。     

青年缺血性脑卒中的病因及危险因素分析

目的分析青年缺血性脑卒中的病因及危险因素。方法回顾性分析我院2012-10—2014-10収治的96例青年缺血性脑卒中患者的临床资料,并随机抽取同期住院的老年脑卒中患者100例进行对照,分析青年缺血性脑卒中的病因及危险因素。结果青年组与老年组危险因素比较发现,高血压、高脂血症、吸烟、饮酒所占的比例最高,考虑动脉粥样硬化仍是青年缺血性脑卒中的主要致病原因。2组经TOAST病因学分型后发现,病因主要是大动脉粥样硬化型(分别为42.7%和47.0%),其次为小动脉闭塞型(分别为27.1%和33.0%),老年组心源性栓塞型高于青年组(分别为16.0%和6.2%),而青年组的其他病因型及不明原因型高于老年组(分别为17.7%、6.3%和2.0%、2.0%)。结论对于缺血性青年卒中患者,需完善各项检查,以便于寻找病因,排除危险因素,为患者提供病因学及个性化治疗方案,以改善患者的生命质量。     

卵圆孔未闭与隐源性卒中的研究进展

经过全面筛查,仍有约40%找不到明确病因的缺血性卒中为隐源性卒中。卵圆孔未闭可引 起反常栓塞,进而发生缺血性卒中。近年来发现,部分隐源性卒中可能由卵圆孔未闭导致。本文将从 检查方法、作用、机制及治疗等方面对卵圆孔未闭与隐源性卒中的研究现状进行介绍。     

青年缺血性脑卒中的病因及危险因素研究现状

正近年来青年缺血性脑卒中发病率呈逐年增高趋势,同中老年缺血性脑卒中相比,其病因及危险因素相对复杂。研究表明,早发性动脉粥样硬化仍是青年脑卒中的最常见病因,通常受高血压病、糖尿病、高脂血症、吸烟和年龄等传统危险因素的影响,然而相当一部分青年脑梗死患者发病前并无这些传统危险因素。随着研究的深入,其他脑血管病危险因素如先天性卵圆孔未闭、肿瘤、阻塞性睡眠呼吸暂停低通气综合征、遗传性单基因病等在青年缺血性脑卒中患者中亦不少     

不明原因晕厥与心脏卵圆孔未闭高度相关

目的探讨不明原因晕厥与卵圆孔未闭的相关性。方法选取61例不明原因晕厥的门诊及住院患者,进行右心声学造影检查,筛查是否合并卵圆孔未闭,并对检查结果进行统计学分析,确定不明原因晕厥与卵圆孔未闭之间是否存在某种关联。结果 61例不明原因晕厥患者中46例(男21例,女25例)为心脏卵圆孔未闭患者(75.41%)。46例患者中,30例静息状态下及Valsalva动作后均发生右向左分流,16例仅在Valsalva动作后出现分流;少量分流7例,中量分流5例,大量分流34例;13例在运动中起病,22例在腹压变化时起病,11例在静息状态下起病。26例患者行经导管卵圆孔未闭封堵术治疗,术后随访1~6个月,仅有2例患者再发晕厥一次,余患者均未再发晕厥。结论心脏卵圆孔未闭为不明原因晕厥常见的诱因,不明原因晕厥与心脏卵圆孔未闭高度相关,不明原因晕厥患者应常规筛查心脏右向左分流。     

Cost-Effectiveness Analysis of Percutaneous Patent Foramen Ovale Closure Preventing Secondary Ischemic Stroke in Japan

ObjectivesPatent foramen ovale is a hemodynamically insignificant interatrial communication that may cause ischemic stroke. Percutaneous patent foramen ovale closure reduces the risk for recurrent ischemic stroke in patients with a history of cryptogenic ischemic stroke. This study evaluated the cost-effectiveness of patent foramen ovale closure against medical therapy in patients after their first cryptogenic ischemic stroke in Japan.Materials and methodsThe cost-effectiveness of patent foramen ovale closure compared with medical therapy was evaluated using the Markov model. The target patients started with patent foramen ovale closure or medical therapy for preventing secondary ischemic stroke under a stable state. Quality-adjusted life year was used as the outcome of effectiveness, and the analysis was conducted with a discount rate of 2% applied to both cost and effectiveness. The results of a multicenter open-label randomized controlled trial (RESPECT trial) evaluating patent foramen ovale closure using the Amplatzer? PFO Occluder were used as clinical evidence. Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio. It was evaluated as cost-effective if it was lower than 5 million JPY/ quality-adjusted life year.ResultsPatent foramen ovale closure was dominant over medical therapy by 2.53 quality-adjusted life years and an estimated cost reduction of 2,353,926 JPY. The probability of patent foramen ovale closure being dominant was 82.9%.ConclusionsPatent foramen ovale closure was dominant over medical therapy for preventing secondary ischemic stroke in patients with cryptogenic ischemic stroke.     

Long-term risk of recurrent stroke in young cryptogenic stroke patients with and without patent foramen ovale

Background Among patients with a patent foramen ovale and cryptogenic ischemic stroke, the long-term prognosis is unclear. Aims This study aims to estimate the recurrence rate in young cryptogenic stroke patients with and without patent foramen ovale. Patients and methods One hundred eighty-six cryptogenic stroke patients (aged 18-45 years) were prospectively followed for up to five-years. They were divided into two groups according to the echocardiographic presence of patent foramen ovale. All patients received aspirin (100?mg/day) for secondary prevention. Results Mean age was 32·3 (standard deviation 7·9) years. During the mean follow-up of 66 months five patients with patent foramen ovale had recurrent strokes compared with 11 patients without patent foramen ovale. The average annual rate of recurrent cerebral ischemia was 1·1% and 1·6% for patients with and without patent foramen ovale, respectively. The recurrence rate did not increase with the presence of patent foramen ovale, atrial septal aneurysm or other variables. More than 60% of the reported cases achieved a good functional outcome. Conclusions Young patients with cryptogenic ischemic stroke with and without patent foramen ovale have a low recurrence rate in a long-term follow-up and most present a favorable outcome. Patent foramen ovale with or without atrial septal aneurysm did not increase the risk of recurrence.     

Patent foramen ovale in young stroke patients with mitral valve prolapse

Because mitral valve prolapse and patent foramen ovale are supposed to promote stroke in young patients, we assessed the frequency of patent foramen ovale in 18 patients younger than 45 years with stroke and mitral valve prolapse diagnosed on echocardiography at the time of stroke, who were admitted to 2 university hospitals. Eleven patients were called back to hospital for contrast transthoracic and/or transesophageal echocardiography, 3 to 7 years after their initial stroke. A patent foramen ovale was found in 9 patients (50%). In 4 re-assessed patients no mitral valve prolapse was found using our present criteria. Six patients with mitral valve prolapse had a patent foramen ovale (43%). Our results suggest that mitral valve prolapse is commonly associated with patent foramen ovale in young stroke patients.     

Behavioral situation at onset of paradoxical brain embolism due to patent foramen ovale]

The goal of this study was to determine whether there was difference in behavioral situation at onset of stroke between the patients with right-to-left shunt whose stroke was diagnosed as paradoxical brain embolism according to the new criteria proposed by Strategies against Stroke Study for Young Adults in Japan (SASSY-Japan) and whose stroke was not. Among 365 consecutive patients with possible acute ischemic stroke who underwent transesophageal echocardiography, we compared clinical profiles of the following three patient groups: patients with patent foramen ovale whose stroke was diagnosed as paradoxical brain embolism (group A), patients with patent foramen ovale whose stroke was not diagnosed as paradoxical brain embolism (group B), and patients without patent foramen ovale whose stroke was diagnosed as cardiogenic brain embolism (group C). Patent foramen ovale was present on echocardiogram in 76 of 365 patients (21%). Among them, 19 patients were classified into group A and 34 into group B. Group C was composed of 69 patients. At stroke onset, 3 patients in group A took behavior with positive Valsalva maneuver, 2 in group B, and 1 in group C. Similarly at stroke onset, 4 patients in group A just stood up from long-time sitting position, 1 in group B, and 1 in group C. In all, stroke onset following Valsalva maneuver or long-time sitting position was positive in 37% of group A, 9% of group B, and 3% of group C, and was most frequent in group A (p < 0.0001). In group A, the frequency of Valsalva maneuver or long-time sitting position at stroke onset was higher than the frequency of detection of venous thrombus (21%). The result indicates that Valsalva maneuver and long-time sitting position contribute to occurrence of paradoxical brain embolism. We think that these behavioral situations are appropriate diagnostic criteria for paradoxical brain embolism.     

Patent foramen ovale. What is it and what does it indicate?

Cryptogenic stroke accounts for up to 40 % of all ischemic strokes and is even more frequent in young patients. The patent foramen ovale (PFO) is found in almost 60% of these young patients and has been suggested as a potential cause of cryptogenic stroke in this age group. However, the pathological relevance of PFO in cryptogenic stroke and the most appropriate therapeutic handling of it have not been established. In this review, the current state of therapeutic handling and ongoing controversies are discussed and the most interesting results in this field, including recent metaanalyses, are presented.     

Cerebrovascular events on awakening, patent foramen ovale and obstructive sleep apnea syndrome

Patent foramen ovale is a defect in the interatrial septum associated with cryptogenic stroke. The presumed mechanism of cryptogenic stroke due to a patent foramen ovale is the migration of thrombus from the venous side of the circulation to the left atrium with subsequent systematic embolism, called paradoxical embolization. Provacative maneuvers and pre-existing cardiopulmonary disease can cause elevation in right atrial pressure leading to right-to-left shunting through a patent foramen ovale. We report two patients with patent foramen ovale waking up with cryptogenic vascular events and found to have an obstructive sleep apnea syndrome. During nocturnal sleep, obstructive sleep apnea can cause right atrium pressure elevation resulting in right-to-left shunting through patent foramen ovale. The possibility of patent foramen ovale and an obstructive sleep apnea syndrome may be considered in patients with cryptogenic strokes-on-awakening. Further studies are needed to support our observation.     

Hemolytic anemia presenting as idiopathic intracranial hypertension

The authors report three cases of ischemic stroke in young adults that occurred during or after an airplane flight. Workup was negative for any cause of stroke other than the presence of a patent foramen ovale (PFO). There is an increasing awareness of deep vein thrombosis and pulmonary embolism occurring in relation to long flights. Individuals with a PFO under these circumstances may be vulnerable to stroke from paradoxic embolism. "Economy class" stroke syndrome may be underdiagnosed and is an eminently preventable cause of stroke.     

Abnormalities of interatrial septum and ischemic stroke in young people

OBJECTIVE: To verify the frequency of patent foramen ovale (PFO) among patients with ischemic stroke (cryptogenic or with a known cause) investigated by transcranial doppler (TCD) and transesophageal echocardiography. Secondarily, to determine the diagnostic validity of the former, compared with the later method. METHOD: Retrospectively, 124 patients (<51 years old) with ischemic stroke were submitted to TCD and or transesophageal echocardiography. The patients were classified as cryptogenic stroke or not. RESULTS: We could found an important association between cryptogenic ischemic stroke and PFO (odds ratio 4.3--CI 95% 1.7-10.7). Only five cases of interatrial septal aneurysm were diagnosed among patients with PFO. Sensitivity, specificity and positive and negative predictive values exhibited values upper of 85%, equivalents, at least based on confidence intervals. CONCLUSION: We could determine, for the first time in our country, a strong association between cryptogenic ischemic stroke and PFO. The TCD is a valuable diagnostic resource in this context since its validity was considered excellent. A detailed investigation in these cases should always be done due to the possibility of FOP closure.     

经导管封堵治疗卵圆孔未闭并发隐匿性脑卒中或短暂性脑缺血发作的临床效果

目的 探讨经导管封堵治疗卵圆孔未闭并发隐匿性脑卒中或短暂性脑缺血发作的临床效果。方法 选取本院2016年2月-2018年8月收治的120例卵圆孔未闭并发隐匿性脑卒中或短暂性脑缺血发作患者为研究对象,分为对照组和实验组,每组各60例,对照组患者采用阿司匹林进行治疗,实验组患者进行经导管封堵治疗,观察2组患者的治疗效果、治疗前、治疗6个月后的临床指标水平变化、治疗前、治疗6个月后的血栓弹力图(TEG)指标水平变化以及治疗6个月后的并发症发生率和脑缺血事件复发率。结果 实验组的治疗效果明显好于对照组(P<0.05); 治疗6个月后实验组的射血分数、左室舒张末内径、心率和左室收缩末内径均高于对照组(P<0.05); 治疗6个月后实验组的α-角和MA值明显低于对照组,AA途径诱导的血小板控制率明显高于对照组(P<0.05); 治疗6个月后实验组的并发症发生率和脑缺血事件复发率明显低于对照组(P<0.05)。结论 经导管封堵对卵圆孔未闭并发隐匿性脑卒中或短暂性脑缺血发作的临床效果较好,可以提高患者的心功能,明显降低血小板聚集,降低患者的脑缺血事件复发率和并发症发生率